- MeSH
- Hospitalization MeSH
- Humans MeSH
- Young Adult MeSH
- Parenteral Nutrition MeSH
- Diarrhea etiology pathology MeSH
- Colitis, Ulcerative * complications therapy MeSH
- Check Tag
- Humans MeSH
- Young Adult MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Akutní průjem bývá nejčastěji infekčního původu, základem terapie je rehydratace, dieta a optimální farmakoterapie. U chronických průjmů je základem správná diagnostika, neměli bychom zapomínat na méně časté příčiny průjmů, jako jsou nežádoucí účinky léčiv, syndrom dráždivého tračníku nebo nežádoucí reakce na potraviny. Sdělení se věnuje těmto příčinám, jejich prevenci a terapii.
Acute diarrhea has most commonly an infectious origin, the basis of pharmacotherapy is rehydration, diet, and optimal pharmacotherapy. With chronic diarrhea, the basis is correct diagnosis, we should not forget less common causes of diarrhea, such as side effects of drugs, irritable bowel syndrome, or adverse reactions to food. The communication is devoted to these causes, their prevention, and therapy.
Role farmaceuta i farmaceutického asistenta zahrnuje poradenství v oblasti léčivých přípravků vydávaných bez lékařského předpisu při samoléčbě různorodých zažívacích potíží. Tento článek přináší základní přehled léčivých přípravků vydávaných bez lékařského předpisu pro léčbu průjmu, zácpy a dyspepsií - jejich indikací, kontraindikací a možných nežádoucích účinků jejich podání.
The pharmacist and pharmaceutical assistant roles include counseling in the field of over-the-counter medicinal products in the self-treatment of various gastrointestinal problems. This article provides a basic overview of over-the-counter medicinal products for the treatment of diarrhea, constipation, and dyspepsia - their indications, contraindications, and possible adverse effects of their administration.
Průjmová onemocnění patří v České republice k nejčastějším hlášeným infekčním onemocněním, i když v souvislosti s pandemií covidu-19 a velmi dlouhým lockdownem jejich počet loni poklesl (v r. 2020 bylo v České republice hlášeno jen 38 803 infekčních průjmových onemocnění). K nejběžnějším etiologickým agens patří kampylobaktery (17 786 případů), salmonely (10 364 případů), Clostridium difficile, rotaviry a noroviry. V článku je popsána epidemiologie, klinický obraz, diagnostika, diferenciální diagnostika a léčba průjmových onemocnění.
Diarrheal diseases are among the most commonly reported infectious diseases in the Czech Republic, although in connection with the pandemic covid-19 and a very long lockdown their number decreased last year (in 2020 only 38 803 cases were reported in the Czech Republic). The most common etiological agents include campylobacters (17 786 cases) salmonellas (10 364 cases), Clostridium difficile, rotaviruses and noroviruses. The article describes the epidemiology, clinical picture, diagnosis, differential diagnosis and treatment of diarrheal diseases.
- MeSH
- Dehydration classification pathology MeSH
- Diagnosis, Differential MeSH
- Child MeSH
- Feces MeSH
- Gastroenteritis diagnosis drug therapy complications therapy MeSH
- Hospitalization MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Diarrhea * diagnosis etiology drug therapy pathology therapy MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
Onemocnění gastrointestinálního traktu (GIT) vede často ke změnám vnitřního prostředí, resp. změnám objemu extracelulární tekutiny, sérových koncentrací elektrolytů a acidobazické rovnováhy. V celém rozsahu zažívacího traktu dochází k velkému obratu vody a elektrolytů. GIT se podílí na vstřebávání i exkreci vody a elektrolytů a významně zasahuje do regulace bikarbonátového pufrovacího systému. Sliznice GIT secernují řadu šťáv. Za patologické situace (zvýšená sekrece, snížená reabsorpce) tak dochází k deregulaci homeostázy vnitřního prostředí. Tyto poruchy mohou mít různou intenzitu klinicko-laboratorní symptomatologie, od náhodně zjištěné laboratorní abnormality až po život ohrožující stavy. Následující přehledový článek shrnuje problematiku hyponatremie - nejčastější poruchy vnitřního prostředí - v souvislosti s onemocněními GIT. Jsou diskutovány různorodé klinické situace, které mohou být s hyponatremií spojeny. Hyponatremie bývá navíc často provázena řadou dalších abnormalit vnitřního prostředí a v jejich kontextu je potřeba ji také vnímat. Je nutné zajistit řadu údajů - jednak anamnestických, jednak laboratorních, které jsou v průběhu léčby modifikovány. Neméně důležité je pečlivé provedení základního fyzikálního vyšetření zaměřeného na stav hydratace. Porozumění patofyziologickým mechanismům rozvoje hyponatremie spolu s podrobnou analýzou klinicko-laboratorního obrazu je jedinou cestou ke správné diferenciální diagnóze hyponatremie, která je zpětně bez těchto znalostí nemožná. Pro lékaře napříč všemi odbornostmi je důležité respektovat doporučená laboratorní vyšetření před iniciací terapie tak, aby je mohli posléze sami nebo s pomocí odborníka později interpretovat.
Diseases of the gastrointestinal tract (GIT) often lead to changes in the homeostasis of serum electrolyte concentrations and of acid-base and water balance. There is a large turn in water and electrolytes throughout the digestive tract. GIT is involved in electrolyte balance, water absorption, and excretion. GIT mucosa secretes a large amount of juices. Pathological conditions (increased secretion or decreased reabsorption) contribute to the deregulation of homeostasis of the internal environment. These disorders can vary in intensity from accidentally detected laboratory abnormalities to life-threatening conditions. The following review article addresses hyponatremia - the most common disorder of the internal environment - in the context of GIT diseases. The various clinical situations that may be associated with hyponatremia are discussed. In addition, hyponatremia is often accompanied by a number of other abnormalities of the internal environment, these must be respected during the treatment. It is necessary to obtain a range of data - both anamnestic and laboratory data - including changes in these data during the course of treatment. Equally important is the careful execution of a basic physical examination focusing on hydration. Understanding the pathophysiological mechanisms that lead to hyponatremia, along with detailed clinical-laboratory image analysis, is the only way to obtain an accurate differential diagnosis of hyponatremia. For physicians across all areas of expertise, it is important to perform recommended laboratory tests prior to therapy initiation, afterwards these data enable us the correct interpretation of the abnormalities.
- MeSH
- Diagnosis, Differential MeSH
- Gastrointestinal Diseases * MeSH
- Hyponatremia * etiology drug therapy physiopathology MeSH
- Liver Cirrhosis physiopathology MeSH
- Colonoscopy adverse effects MeSH
- Humans MeSH
- Metabolic Diseases MeSH
- Diarrhea etiology pathology MeSH
- Vomiting etiology pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
This study aimed to detect virulence factors, pathovars, and phylogenetic groups of Escherichia coli strains obtained from feces of calves with and without diarrhea up to 70 days old and to determine the association between occurrence of diarrhea, phylogenetic groups, and pathovars. Phylo-typing analysis of the 336 E. coli strains isolated from calves with Clermont method showed that 21 (6.25 %) belong to phylogroup A, 228 (67.85 %) to phylogroup B1, 2 (0.6 %) to phylogroup B2, 5 (1.49 %) to phylogroup C, 57 (16.96 %) to phylogroup E, and 3 (0.9 %) to phylogroup F. Phylogroup D was not identified and 20 strains (5.95 %) were assigned as "unknown." The distribution of phylogenetic groups among pathovars showed that NTEC belong to phylogroups B1 (17) and C (4); EPEC to phylogroups B1 (6) and E (8); STEC to phylogroups A (5), B1 (56), B2 (2), C (1), and E (15); EHEC to phylogroups B1 (95) and E (5); and ETEC to phylogroups A (3), B1 (7), and E (10). The EAST-1 strains were phylogroups A (13), B1 (47), E (19), and F (3); E. coli strains of "unknown" phylogroups belonged to pathovars EPEC (1), EHEC (2), STEC (7), and EAST-1 strains (6). ETEC was associated with diarrhea (P = 0.002). Our study did not find association between the phylogenetic background and occurrence of diarrhea (P = 0.164) but did find some relationship in phylogenetic group and pathovar. The study showed that EHEC and STEC are classified as phylogroup B1, EAST-1 phylogroup A, ETEC, and EPEC phylogroup E.
- MeSH
- DNA, Bacterial genetics MeSH
- Enteropathogenic Escherichia coli classification genetics growth & development pathogenicity MeSH
- Enterotoxigenic Escherichia coli classification genetics growth & development pathogenicity MeSH
- Gene Expression MeSH
- Virulence Factors genetics metabolism MeSH
- Feces microbiology MeSH
- Phylogeny MeSH
- Genotype MeSH
- Escherichia coli Infections diagnosis microbiology pathology veterinary MeSH
- Cattle Diseases diagnosis microbiology pathology MeSH
- Polymerase Chain Reaction MeSH
- Diarrhea diagnosis microbiology pathology veterinary MeSH
- Shiga-Toxigenic Escherichia coli classification genetics growth & development pathogenicity MeSH
- Cattle MeSH
- Bacterial Typing Techniques MeSH
- Virulence MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Cattle MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Brazil MeSH
PURPOSE: The objective of this survey was to determine the incidence of Clostridium difficile infections (CDI) at the Department of Infectious Diseases, Bulovka Hospital, and to evaluate clinical and epidemiological data on CDI patients together with a detailed molecular characterisation of C. difficile isolates. The patient outcomes were correlated to causative C. difficile PCR-ribotype. METHODS: The twelve-month study (2013) comprised patients two years of age and older with CDI. CDI severity was estimated using ESCMID criteria and ATLAS scoring. C. difficile isolates were further characterized using ribotyping, Multiple-Locus Variable Tandem-Repeats analysis (MLVA) and investigation of antibiotic-resistance determinants (gyrA, gyrB, rpoB, ermB). RESULTS: A total of 619 diarrhoeal stools were investigated. Seventy-two stool samples were GDH and toxin A/B positive, and 39 samples were GDH positive only and subsequently toxigenic C. difficile was cultured. In total, 111 C. difficile isolates were characterized, of which 64 (57.7%) belonged to PCR-ribotype 176. MLVA analysis of PCR-ribotype 176 isolates revealed 11 clonal complexes. Seventy-two isolates (64.9%) showed amino acid substitution Thr82Ile in the GyrA, and sixty-two isolates (55.9%) showed amino acid substitutions Arg505Lys together with His502Asn, or Asp492Glu together with Arg505Lys in the RpoB. Twelve isolates (10.8%) were ermB positive. Severe CDI according to the ESCMID criteria was recorded in forty-two patients (37.8%), and sixteen patients (14.4%) had ATLAS score ≥ 6. Twenty-nine patients (26.1%) had recurrent CDI and twenty-four patients (21.6%) died during the study period. CONCLUSIONS: A higher rate of severe CDI, recurrences and mortality in association with PCR-ribotype 176 infections were observed. The high incidence of PCR-ribotype 176 in the study, and the presence of clonal relatedness between PCR-ribotype 176 isolates, indicate its higher capacity to spread in a hospital setting, which in turn highlights the need to implement strict epidemic measures when PCR-ribotype 176 occurs.
- MeSH
- Survival Analysis MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Drug Resistance, Bacterial genetics MeSH
- Bacterial Proteins genetics MeSH
- Clostridioides difficile classification drug effects genetics isolation & purification MeSH
- Child MeSH
- Adult MeSH
- Gene Expression MeSH
- Cross Infection diagnosis drug therapy mortality pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Multilocus Sequence Typing MeSH
- Mutation MeSH
- Child, Preschool MeSH
- Diarrhea diagnosis drug therapy mortality pathology MeSH
- Enterocolitis, Pseudomembranous diagnosis drug therapy mortality pathology MeSH
- Retrospective Studies MeSH
- Ribotyping MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Sartanová enteropatie je sprue podobné průjmovité onemocnění asociované s užíváním sartanů (především olmesartanu), při kterém prokazujeme poškození tenkého střeva, nejčastěji v podobě vilózní atrofie s lymfocytární infiltrací lamina propria, v některých případech s intraepiteliální lymfocytózou a/nebo subepiteliálními kolagenními depozity. Současně je nutné vyloučit jiné příčiny enteropatie, především celiakii. Onemocnění může mít i závažný průběh, ale vysazení léku vede k uzdravení, příznaky je možné reprodukovat znovunasazením léku. Vzhledem k množství olmesartanem léčených pacientů se tento nežádoucí účinek objevuje vzácně. V kohortě pacientů s neceliakální sprue se však jedná o častou a důležitou diferenciálně diagnostickou možnost. Onemocnění vzniká pravděpodobně autoimunitním mechanizmem u predisponovaných jedinců. Prezentujeme případ pacientky s enteropatií asociovanou s užíváním telmisartanu.
Sartan-associated enteropathy is a sprue-like diarrhoeal disease induced by sartans (especially olmesartan) and is characterised by damage to the small intestine. Villous atrophy with lymphocytic infiltration of lamina propria is usually present and can be associated with intraepithelial lymphocytosis and/or subepithelial collagen deposits. The course of the disease is sometimes severe; however, withdrawal of medication leads to the complete reversal of symptoms and drug re-challenge results in the reappearance of the clinical signs of the disease. This side effect of the drug is relatively rare compared with the number of patients treated with olmesartan. Nevertheless, it represents a frequent and important diagnostic alternative in cohorts of patients with non-coeliac sprue. The disease is presumably caused by an autoimmune mechanism in predisposed individuals. We present a case report of telmisartan-associated enteropathy.
- Keywords
- olmesartan – sprue – enteropatie – blokátory receptoru typu 1 pro angiotensin II – celiakie, olmesartan – sprue – enteropathy – angiotensin II type 1 receptor blockers – celiac disease The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 26. 8. 2015 Accepted: 22. 9. 2015,
- MeSH
- Angiotensin II Type 1 Receptor Blockers * adverse effects MeSH
- Hypertension drug therapy MeSH
- Ileum anatomy & histology MeSH
- Clinical Laboratory Techniques MeSH
- Colonoscopy utilization MeSH
- Comorbidity MeSH
- Humans MeSH
- Ileal Diseases * diagnosis chemically induced pathology therapy MeSH
- Diarrhea diagnosis chemically induced pathology therapy MeSH
- Aged MeSH
- Intestinal Mucosa pathology drug effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
